A Call to Health Professionals Interested in the Israeli-Palestinian Conflict:
Recommendations based on Richard Horton’s Article in the New York Review of Books
.
I am dividing this commentary into two parts – a summary of my reflections as executive
director of Healing Across the Divides (HATD: www.healingdivides.org) on the political
and health implications of Dr Horton’s essay that appeared recently in the New York
Review of Books. I then detail specific suggestions that can build on Dr Horton’s essay to
materially assist Palestinians as they confront the ongoing and ever increasing health
crisis. It is a crisis from which I do not see any short term solutions. We need to work for
the long term.
My comments on Dr Horton’s essay are written as executive director of Healing Across
the Divides. All my comments are meant to be challenging yet constructive to all reading
this essay, from either their personal and/or organizational vantage points. I am similarly
hopeful that representatives of all groups reading this essay ranging across the political
spectrum in the United States, Europe and the Middle East can either support the
suggestions both politically and financially or provide concrete suggestions on how to
improve the current health care crisis facing Palestinians.
My overall comments can be summed up in two sentences: In a troubled world
confounded by many Middle East crises to which the U.S. unfortunately has not made a
positive contribution, health care professionals need to take all measures to support nongovernmental Palestinian run health care organizations. Only an empowered Palestinian
health care organization can take the long term perspective on the Israeli-Palestinian
conflict, and, in turn, empower the Palestinians they are serving to take charge of their
lives within a community framework.
My specific suggestions/observations are:
 My medical colleagues should not expect world opinion to make the “necessary
political changes” that will result in the alleviation of the Palestinian medical
crisis simply because it is the “right thing to do”. Both sides of the “divide” have
“facts” that are “true”; they are just rather different facts. Appealing to any
European and/or American medical organizations to exert political pressure on
their own and/or any Middle Eastern countries is unlikely to be successful. Except
in health care situations impacting politically extremely weak actors such pressure
has historically never been successful and the Palestinian situation is
incomparably more complex than other similarly deserving situations confronting
us today such as Darfur or shall we be honest and mention Chechnya and/or
Rwanda – the list goes on and on.
 All health professionals and communal/political leaders of all religious/ political
stripes should consider ways of providing all necessary medical aid to nongovernmental Palestinian run organizations. Palestinian health professionals are
completely capable of providing services to their nationals that will result not only
in improved health but, and this is the key, empowered citizens. As I will discuss
in detail below, community based health empowerment facilitated by Palestinian
organizations is not only working today but is inexpensive. Delivered in
measured (defined as methodical with evidence based measured impact) steps
over the next few years, 100 million dollars per year would cover all aspects of
community empowerment for all Palestinians.
Unless Palestinians are empowered to take charge of their lives we will simply be
accomplices to a worsening health care and societal crisis. For Palestinians this will
result in an unimaginable epidemic of mortality from chronic illnesses behind an
increasingly unseen wall of separation. Palestinian health professionals can today reverse
this epidemic – if they are empowered with the necessary resources.
Now for more detailed comments on Dr Horton’s essay ;
1. In an ideal world, we would adopt the social medicine perspective and take into
account the nexus between health status and social/political determinants of
health. Unfortunately, as someone who has worked in the region for almost thirty
years, I see little future for this approach. Just as importantly, Palestinians have
not internalized the fact that even if their cause is “just” that fact does not ipso
facto lead to any political changes. The reason is that Israelis in power (and this
applies across their political spectrum) believe that their cause is equally “just”.
Israelis as a consequence have a developed a consensus that ineluctably leads to
settlement expansion as part of the victim national narrative Israeli political elites
adhere to.
In large measure the problem is that both sides passionately believe that they own
a narrative that places them in the victim position. Such a narrative demands that
the other side take the initial steps toward a peace settlement. Unfortunately, to
alter this scenario would require brave Israeli and/or Palestinian leaders – and
such leaders do not appear to be in great supply. Alternatively, we would need
clear-minded Western, particularly American, leaders who would be willing to
cajole both sides into an agreement. Such political will is not on the horizon. As a
consequence, conversations, for example, with the Israeli Medical Association
(IMA) that are reported on in Dr Horton’s essay are unlikely to bear fruit.
Most Palestinian health professionals realize the highly problematic nature of
talks with the IMA. However, Palestinians still tenaciously hold to the belief that
since they believe in the “justness” of their narrative, political changes represent
the route to health improvement. I would encourage all of you reading this
commentary to consider that an equally worthwhile road to such a Palestinian
state at peace with Israel may come not only from the top down but also from the
bottom up. Not from political leadership of whatever stripe down to the
community – the political leadership is today nowhere to be seen in any part of
the world. I encourage all Palestinian health professionals to consider spending as
much political capital as possible on community empowerment in addition to the
political process. Such an approach represents a road to peace that the UPMRC is
already implementing with modest help from HATD.
2. Regarding practical approaches to address the ever worsening Palestinian health
care crisis, Dr Horton’s essay highlights, in particular, yeoman efforts by groups
such as the Union of Palestine Medical Reflief Committees or UPMRC (one of
several Palestinian groups HATD supports). There is one area in particular I
would highlight-the effort by health professionals, ranging from community
health workers to physicians, to encourage their patients to not only believe that
life is worth living but, to empower them to take charge of their lives. . The
UPMRC not only helps in a clinical manner with thousands of individuals but, via
community empowerment, works to improve the lives of people who even under
abject circumstances are better able to care for themselves. Such an approach has
the potential of impacting the entire Palestinian population.
HATD has funded several projects aimed at improving the control of diabetics
using the community based approach that the UPMRC has pioneered through its
School of Community Health Workers. I am enclosing an article published in a
peer reviewed journal that documents the impact of the initial pilot effort on
several hundred diabetics. I am also enclosing part of the questionnaire that is
collected on every patient – not just classical diabetes outcomes but questions
pertaining to empowerment – in the final analysis trying to ascertain whether the
program encourages these Palestinian diabetics to continue to want to live in light
of all the challenges that they face. Ideally, HATD, together with health
professionals throughout the world, would like to work under the UPMRC to
dramatically increase this empowerment.
.In conclusion, via HATD I continue to pursue an approach that emphasizes
empowerment of Palestinian run health care organizations. Empowering these
organizations in a way that results in improved health of all Palestinians will not only
have a salutary impact on health, but also on the empowerment of individuals and even
entire communities. Empowering a diabetic to take care of him/herself not only improves
diabetes control but, more importantly, offers the Palestinian people the community basis
for improving services at a local level which can then be channeled into changes at a
regional or even national level. It may seem a thin reed of hope but empowerment of
Palestinian run organizations (many of whom are led by health care professionals who
are also political leaders) has, most importantly, the potential for sharpening existing
leaders and shaping new Palestinian leaders that will take on new approaches to this
ongoing conflict.